Meniscal repair device

ABSTRACT

An H-type fastener for surgical tissue. The fastener has a central biasing member. The biasing member has a first end and a second end. Anchor members are mounted to each end.

This application is a continuation of Ser. No. 08/766,535 filed Dec. 11,1996.

TECHNICAL FIELD

The field of art to which this invention relates is medical devices fortissue approximation, in particular, medical devices for approximatingsoft tissue.

BACKGROUND OF THE INVENTION

Recent advances in minimally invasive surgical techniques, such anendoscopy, laparoscopy and arthroscopy, have made it possible forcomplex surgical techniques to be performed with minimal disruption andcutting of tissue. These techniques are performed using various types ofscopes which allow the surgeon to visualize the operative site. Thescopes and instruments are designed to be inserted through trocarcannulas which are positioned about the operative site using trocarknives or obturators. The trocar obturators produce minimal punctureswhen inserted into a body cavity or joint. The body cavity or joint istypically insufflated or expanded with a biocompatible gas or liquid,such as carbon dioxide or sterile saline solution in order to providethe surgeon with room to conduct the surgical procedure.

In most surgical procedures, tissue must be approximated to repairwounds and tears and to close incisions. There are numerous knownmethods and devices for approximating tissue. The devices includesurgical needles, surgical sutures, staples and the like. It is alsoknown to use surgical tacks and other fasteners. One particular type offastener which is known is an "H-shaped" fastener. H-type fasteners andmethods of use are disclosed in U.S. Pat. Nos. 4,006,747 and 4,586,502which are incorporated by reference. The H-type fastener typically has acentral connecting section having opposed ends with tissue anchormembers mounted to each end. H-type fasteners and fastening systems fornon-medical use are commonly used to affix labels and tags to clothing.

The H-type fasteners may have advantages over conventional fasteners incertain minimally invasive techniques. In particular, it is known to useH-type fasteners in arthroscopic techniques such as meniscal repair asdisclosed in U.S. Pat. No. 5,320,633. Damage to the meniscus, such asrips or tears, has been found to be repairable if the torn pieces of themeniscus are approximated. At one time, the prevailing practice was suchthat the torn sections of the meniscus would be surgically removed,eventually resulting in damage to the bones in the joint caused bybone-on-bone contact. Presently, however, it has been found that, inorder for the meniscal repair to be effective, the opposing surfaces ofthe torn or ripped meniscus must be approximated such that the surfacesare maintained in close contact.

The H-type fasteners are believed to be effective in meniscal repairsince they are relatively easy to insert using a conventional apparatushaving a cannulated distal needle wherein the needle has a longitudinalslot. One leg or tissue anchor of the H-type fastener is loaded into thecannulated needle, preferably having a slot. The needle is insertedthrough both sides of the meniscal tear and one leg or anchor isexpelled from the needle on one side of the tear. The needle is thenremoved from the meniscus and the other opposed leg or anchor remains inplace positioned on the opposite side of the tear, thereby approximatingthe meniscal tear.

There are certain disadvantages associated with the use of existingH-type fasteners to approximate a tear in a meniscus. One disadvantageis that the surgeon must precisely measure the meniscus prior toinserting the H-type fastener in order to select the proper size H-typefastener. A precise measurement is necessary because the fastener mustbe sized to approximate and compress the opposing sides or surfaces ofthe tear against each other. One skilled in the art will appreciate thedifficulties involved in attempting to obtain such measurements duringan arthroscopic or minimally invasive procedure in which a scope isused. Even if a precise measurement is possible and an appropriatelysized H-type fastener is utilized, proper tissue approximation isdifficult to accomplish since it is often impossible to precisely placea needle in a meniscus, in vivo, especially during an arthroscopicprocedure. Consequently, the meniscus is often under-approximated withinadequate face-to-face contact, or over-approximated with inadequateface-to-face contact. In addition, there are only a limited number ofsizes of H-type fasteners which the surgeon will typically haveavailable during an operative procedure, further complicating thesurgical procedure and the obtention of adequate tissue to tissuecontact in the repaired meniscus. As alluded to above, the surgeon mustprecisely choose the size of the H-type fastener. If the H-type fastenerselected by the surgeon is too large, there will be no tissueapproximation. If the H-type fastener is too small, the tissue may foldand bunch, possibly turning the edges or surfaces of the tear so thatthey are not in contact with each other, thereby effecting only apartial or inadequate repair.

What is needed in this art are improved H-type surgical fasteners forapproximating tissue which overcome the disadvantages associated withthe H-type fasteners of the prior art.

DISCLOSURE OF THE INVENTION

It is an object of the invention to provide an H-type fastener having abiasing section which, when inserted through two adjacent sections ofbody tissue, causes the edges or surfaces of the tissue to compressagainst each other.

It is yet another object of the present invention to provide an H-typefastener which eliminates or minimizes the need to make precise in-vivomeasurements of tissue prior to insertion.

It is still yet a further object of the present invention to provide amethod of surgically approximating tissue using an H-type fastenerhaving a biasing section, said biasing section providing a biasing forceto maintain the edges or surfaces of tissue about a tear approximated.

Accordingly, an H-type fastener is disclosed. The H-type fastener has acentral elongated biasing member having a first end and a second end.Mounted to the first end of the biasing member is a first tissue anchor.Mounted to the second end of the biasing member is a second tissueanchor. The elongated biasing member has a resting position, and may beelastically deformed to an extended position. In the extended position,the biasing member exerts a biasing force. The biasing member may havevarious resting position configurations including saw tooth waves, sinewaves, helixes, arcs, parabolas, combinations of straight and curvedsections, and the like. The tissue anchors may similarly have a varietyof configurations and may be rod-shaped, disk-shaped, spherical, etc.

Yet another aspect of the present invention is an H-type fastener. TheH-type fastener has an elongated central connecting member having afirst end and a second end. Mounted to the first end of the centralmember is a first biasing tissue anchor. Mounted to the second end ofthe connecting member is a second biasing tissue anchor. The biasingtissue anchors have a first resting configuration and a secondelastically deformed configuration. When elastically deformed, thetissue anchors exert a biasing force.

Yet another aspect of the present invention is a method of approximatingtissue using the tissue approximating devices of the present invention.The method consists of inserting an H-type fastener of the presentdevice having a central biasing section into tissue. Next, one tissueanchor is moved to a first position in or about the tissue, and thesecond anchor is moved to a second position in or about the tissue suchthat the biasing section is elastically displaced from its restingposition to an extended position, thereby causing tissue between theanchors to be approximated and causing a biasing force to be exertedupon the tissue.

Still yet another aspect of the present invention is a method ofapproximating tissue using the tissue approximating devices of thepresent invention. The method consists of inserting an H-type fastenerof the present device having biasing tissue anchors and a non biasingcentral member into tissue. Next, one biasing tissue anchor is moved toa first position in or about the tissue, and the biasing second anchoris moved to a second position in or about the tissue such that thebiasing tissue anchors are elastically displaced from their restingpositions to extended positions, thereby causing tissue between theanchors to be approximated and causing a biasing force to be exertedupon the tissue. The biasing anchors may also have a variety ofconfigurations including V-shaped, X-shaped, etc.

These and other aspects of the present invention will become moreapparent from the following description and accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an H-type fastener of the presentinvention having a semicircular biasing section.

FIG. 1A is a side view of the H-type fastener of FIG. 1.

FIG. 2 is a perspective view of an H-type fastener of the presentinvention having a helical biasing section.

FIG. 2A is a side view of the H-type fastener of FIG. 2.

FIG. 3 is a perspective view of an H-type fastener of the presentinvention having a biasing section with a saw-tooth configuration.

FIG. 3A is a side view of the H-type fastener of FIG. 3.

FIG. 4 is a perspective view of an H-type fastener of the presentinvention having a sinusoidal biasing section.

FIG. 4A is a side view of the H-type fastener of FIG. 4.

FIG. 5 is a perspective view of an H-type fastener of the presentinvention with a biasing section having a 90° arc-shaped configuration.

FIG. 5A is a side view of the H-type fastener of FIG. 5.

FIG. 6 is a perspective view of an H-type fastener of the presentinventing with a biasing section having a 90° arc configuration, and endanchors which are rotated 90° with respect to each other.

FIG. 6A is a side view of the H-type fastener of FIG. 6.

FIG. 7 is a perspective view of an H-type fastener of the presentinvention wherein the biasing section has a repeating sine waveconfiguration and also having the tissue anchors with longitudinal axeswhich are parallel to each other.

FIG. 7A is a side view of the H-type fastener of FIG. 7.

FIG. 8 is a perspective view of an H-type fastener of the presentinvention wherein the biasing section has two parallel sawtoothconfigurations separated by a central opening.

FIG. 8A is a side view of the H-type fastener of FIG. 8.

FIG. 9 is a perspective view of an H-type fastener of the presentinvention wherein the biasing section has a two adjoining loops.

FIG. 9A is a side view of the H-type fastener of FIG. 9.

FIG. 10 is a perspective view of an alternate embodiment of an H-typefastener of the present inventing having a conventional straight centralconnecting section and V-shaped biasing tissue anchors mounted to theends.

FIG. 10A is a side view of the H-type fastener of FIG. 15.

FIG. 11 is a perspective view of an H-type fastener of the presentinvention wherein the central biasing member is parabolically shaped.

FIG. 11A is a side view of the H-type fastener of FIG. 11.

FIG. 12 is a perspective view of an H-type fastener of the presentinvention wherein one tissue anchor has a disk-like shape and the otheranchor has a rod-like shape; the biasing member as an arc shaped sectionand a straight section.

FIG. 12A is a side view of the H-type fastener of FIG. 12.

FIG. 13 is a cross-section of a biasing section of an H-type fastener ofthe present invention having a circular configuration.

FIG. 14 is a cross-section of a biasing section of an H-type fastener ofthe present invention having an elliptical configuration.

FIG. 15 is a cross-section of a biasing section of an H-type fastener ofthe present invention having a rectangular configuration.

FIG. 16 is a cross-section of a biasing section of an H-type fastener ofthe present invention having a configuration consisting of two squares,each joined together diagonally at a corner.

FIG. 17 is a cross-section of a biasing section of an H-type fastener ofthe present invention having a configuration having two circlestangentially connected.

FIG. 18 is a cross-section of a biasing section of an H-type fastener ofthe present invention having a configuration consisting of a rod with acircle at each end.

FIG. 19 is a cross-section of a biasing section of an H-type fastener ofthe present invention having a square configuration.

FIG. 20 is a cross-section of a biasing section of an H-type fastener ofthe present invention having a cross configuration.

FIG. 21 is a top view of a meniscus having a tear.

FIG. 22 is a cross-section of the meniscus of FIG. 21 along view line22--22.

FIG. 23 illustrates an arthroscopic measuring device placed adjacent tothe meniscus of FIG. 21.

FIG. 24 illustrates a cross-sectional view of the meniscus havingemplaced therein an insertion needle with an H-type fastener mounted inthe insertion needle.

FIG. 25 illustrates the meniscus of FIG. 24 after the H-type fastenerhas been deployed from the insertion needle with the insertion needlestill in place in the meniscus.

FIG. 26 illustrates the meniscus of FIG. 25 after removal of theinsertion needle with the H-type fastener fully deployed in place aboutthe tear in the meniscus, such that the tissue about the tear in thevicinity of the fastener is approximated by the biasing force of thecentral biasing section of the fastener.

FIG. 27 is a top view of the meniscus of FIG. 26 illustrating thefastener deployed through the meniscus about the tear and causing thetear to be partially approximated.

FIG. 28 is a top a top view of the meniscus of FIG. 27 after withmultiple H-type fasteners have been deployed through the meniscus aboutthe tear, thereby approximating the tissue about the tear.

FIG. 29 is a cross-sectional view of the meniscus of FIG. 26illustrating the deployment of an additional, supplemental H-typefastener placed above the fastener initially inserted to provideadditional approximation in three dimensions.

FIG. 30 illustrates an H-type fastener of the present invention mountedin an insertion needle.

FIG. 31 illustrates a side view of the insertion needle of FIG. 30.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The H-type fasteners of the present invention may be made from numerousconventional biocompatible polymers. The biocompatible polymericmaterials can be either conventional non-absorbable biocompatiblepolymeric materials, or conventional absorbable or resorbablebiocompatible polymeric materials. Examples of the non-absorbablebiocompatible materials which can be used include polypropylene, nylon,polyethylene, polyester polyolefin and the like and equivalents thereof.The conventional absorbable and resorbable biocompatible polymericmaterials which can be used to manufacture the H-type fasteners of thepresent invention include polydioxanone, polygalactic acid, polylacticacid, polycaprolactone, copolymers and blends thereof as well asequivalents thereof. The polymers may be mixed with bone growthenhancing materials such as calcium hydroxyapatite and the like.Examples of some of the foregoing materials are contained in U.S. Pat.No. 4,052,988 and U.S. Pat. No. 5,252,701. Although not particularlypreferred, those skilled in the art will appreciate that the H-typefasteners of the present invention may be manufactured from otherconventional types of biocompatible materials including metals such asstainless steel spring steel and nickel-titanium alloys, ceramics,composites, and the like and equivalents thereof. The H-type fastenersof the present invention may be manufactured using conventionalmanufacturing processes. For example, when manufacturing the fastenersof the present invention the following processes, among others, may beused: injection molding, insert molding, extrusion molding, thermalbonding, solvent bonding, annealing, heat treatment, mechanicaldeformation, heat fusion, welding, machining cutting, etc.

Referring now to FIG. 2, a preferred embodiment of an H-type fastener 10of the present invention is illustrated. The fastener 10 is seen to havecentral helically-shaped biasing section 12 having first and second ends14 and 16. Biasing member 12 is also seen to have central longitudinalaxis 13. Mounted to the ends 14 and 16 of the biasing member 12 are thetissue anchors 20. As seen in FIG. 2, tissue anchors 20 aresubstantially rod-shaped members having opposed rounded ends 22,although anchors 20 may have other configurations. e.g., spheres, discs,beams, etc. The ends of anchors 20 may also be pointed, flat, conical,pyramidal, etc. The tissue anchors 20 are seen to have longitudinal axes21. The tissue anchors 20 are mounted to the ends 14 and 16 of thebiasing member 12 such that the longitudinal axes 21 of the tissueanchors 20 are substantially perpendicular to the longitudinal axis 13of the biasing member 12. The anchors 20 are also seen to be centrallymounted to the ends 14 and 16. The axes 21 may be parallel or may beangulated with respect to each other or rotated with respect to eachother. An elongation of biasing member 12 from a normal resting positionto and extended position will result in a biasing force being placedupon tissue by anchor members 20 such that when the device 10 is placedinto tissue and the biasing member 10 is elongated, the tissue betweenanchor members 20 will be compressed as a result of the biasing forceexerted upon anchor members 20 by biasing member 12.

Another embodiment of an H-type fastener of the present invention isseen in FIGS. 1 and 1A. The H-type fastener 30 illustrated in FIGS. 1and 1A is seen to have central biasing member 32 having longitudinalaxis 33. Central biasing member 32 is seen to have a semicircularconfiguration with an approximately 180 degree arc, although arcs oflesser magnitude may be used. The biasing member 32 is seen to havelongitudinal axis 33 and first end 34 and second end 36. Mounted to thefirst and second ends 34 and 36 of the biasing member 32 are the tissueanchors 40. The tissue anchors 40 are seen to be substantiallyrod-shaped members having rounded ends 42 and longitudinal axes 43. Therod-shaped anchors 40 are centrally mounted to the ends 34 and 36 suchthat the longitudinal axes 43 of the anchor members are substantiallyperpendicular to the longitudinal axis 33 of biasing member 32 at theends 34 and 36. If desired, the rod-shaped tissue anchors 40 may bemounted in such a manner that their longitudinal axes 43 are angulatedwith respect to each other, for example, at 45°, or are rotated withrespect to each other, for example, at 90° so that the axes 43 of tissueanchors 40 are not in the same plane.

FIGS. 3 and 3A illustrate yet another embodiment of the H-type fastenersof the present invention. The fastener 50 is seen to have centralbiasing section 52 having first and second ends 54 and 56 respectively.The biasing member 52 is seen to have longitudinal axis 57. Mounted tothe first and second ends 54 and 56 of the biasing member 52 are therod-shaped tissue anchors 60. Tissue anchors 60 are rod-shaped memberscentrally mounted to the ends 54 and 56 respectively such that thelongitudinal axes 63 of the anchors 60 are substantially perpendicularto the longitudinal axis 57 of biasing member 52. The biasing member 52is seen to have a saw-tooth configuration.

Another embodiment of an H-type fastener of the present invention isseen in FIGS. 4 and 4A. As seen in FIG. 4, the H-type fastener 70 isseen to have a central biasing section 72 having a sinusoidalconfiguration. Central biasing member 72 is seen to have first andsecond ends 74 and 76 respectively, and longitudinal axis 77. Mounted tothe ends 74 and 76 of the member 72 are the rod-shaped tissue anchors80. The rod-shaped tissue anchors 80 are seen to have longitudinal axes83 and rounded ends 82. The tissue anchors 80 are mounted to the firstand second ends 74 and 76 of biasing member 72 such that thelongitudinal axes 83 of the anchors 80 are substantially perpendicularto the longitudinal axis 77 of the biasing member 72. As mentionedpreviously, the anchors may be mounted in a manner angulated withrespect to each other or rotated with respect to each other.

Yet another preferred embodiment of the H-type fasteners of the presentinvention is seen in FIGS. 5, 5A, 6, and 6A. Referring to FIG. 5, ananchor member 90 is seen to have central biasing section 92 having firstand second ends 94 and 96 respectively. Central biasing member 92 isseen to have a curved configuration, e.g., substantially a 90 degreecircular arc. As seen in FIG. 5A the tissue anchor members 100 arecentrally mounted to the ends 94 and 96 of the biasing member 92 suchthat the longitudinal axes 103 and the longitudinal axis 107 arecoplanar, although angulated with respect to each other. A variation ofthe H-type device 90 is seen in FIGS. 6 and 6A wherein the one tissueanchor member 100 is rotated with respect to the other such that thelongitudinal axes 103 of tissue anchors 100 are no longer coplanar.

Yet another embodiment of the H-type fastener of the present inventionis seen in FIG. 7. The fastener 110 is seen to have biasing section 112having first end 114 and second end 116. Biasing section 112 has arepeating sinusoidal wave-like configuration. Tissue anchor members 120are seen to be rod-shaped members having rounded ends 122 withlongitudinal axes 123 and are seen to be centrally mounted to the ends114 and 116 such that the central axes 123 of anchors 120 aresubstantially perpendicular to the ends 114 and 116.

Another embodiment of the H-type fastener of the present invention isseen in FIG. 8. The H-type device 130 is seen to have central biasingmember 131 having first and second ends 132 and 133 and longitudinalaxis 134. The central biasing member 131 is seen to have opposedsaw-toothed members 135 and central opening 136 separating thesaw-toothed members 135. Mounted to the ends 132 and 133 of biasingmember 131 are the rod-shaped members 137, having longitudinal axes 138and rounded ends 139. The tissue anchors 137 may be mountedperpendicular to longitudinal axis 134 and may be coplanar or rotatedwith respect to each other so that they are not coplanar. Anchors 137may be angulated with respect to each other.

Yet another embodiment of the H-type fastener of the present inventionis seen in FIGS. 9 and 9A. The fastener 140 is seen to have centralbiasing section 141 having double loops 145 and 146 and longitudinalaxis 148. Biasing member 141 is also seen to have ends 142 and 143.Centrally mounted to the ends 142 and 143 are the rod-shaped tissueanchor members 150 having axes 155. The anchor members 150 aresubstantially perpendicular to the ends 142 and 143 and to longitudinalaxis 148, but may be angulated with respect to each other. The tissueanchors 150 may be coplanar or may be rotated about axis 148 so thatthey are not coplanar

Another embodiment of the H-type fastener of the present invention isseen in FIGS. 10 and 10A. The fastener 160 is seen to have centralbiasing section 161 having ends 162 and 163. The biasing member 161 isseen to have straight section 164, intermediate curved section 165, andcurved section 166 adjacent to end 163. The tissue anchors that areattached to the ends 162 and 163 are seen to have different shapes.Rod-shaped tissue anchor member 170 is mounted to end 163 whiledisc-shaped member 175 is centrally mounted to end 162.

Still yet another embodiment of the H-type fasteners of the presentinvention is seen in FIGS. 11 and 11A. Fastener 180 is seen to have aparabolically shaped biasing section 181 having first and second ends182 and 183 and longitudinal axis 184. Mounted to ends 182 and 183 in amanner as previously mentioned are the rod-shaped tissue anchor members186 having curved ends 187 and longitudinal axes 188.

Another embodiment of the H-type fastener of the present invention isseen in FIGS. 12 and 12A. The fastener 190 is seen to have a centralconnecting section 190 which is not a biasing member. Connecting section190 has first and second ends 191 and 192, and longitudinal axis 195.Connecting section 190 preferably has a circular cross-section but mayhave any cross-section including those illustrated in FIGS. 13-20.Mounted to the ends 192 and 193 in a central manner are the biasingtissue anchors 200. Anchors 200 have legs 202 and 203 which areangulated with respect to each other and joined at an apex 205 to form aV-shaped structure. Legs 202 and 203 are seen to angulate inward towardmember 190, but may be situated to angulate in the opposite direction.Anchors 200 may be rotated about axis 195 to be either coplanar or indifferent planes. Deflection of legs 202 and 203 outwardly away frommember 192 from a first resting position to an extended or elasticallydeformed position will produce a biasing force on tissue retainedbetween the anchors 200. Other shapes include U-shapes, a plurality ofoutwardly extending legs or appendages, inverted cone shapes,cylindrical shapes, X-shapes and other structural shapes as mentionedabove for the no-biasing tissue anchors.

Those skilled in the art will appreciate that the configuration chosenfor the central biasing member of the H-type fasteners of the presentinvention will depend upon several factors including, but not limitedto, the magnitude of the biasing force required, the type of tissue tobe approximated, the location within the body of the tissue or organ tobe approximated, the size of the tear or incision in the tissue, whetherabsorbable or non-absorbable material is to be used to manufacture thedevices, the material of construction, the type of surgical procedure,etc. It is within the purview of one skilled in the art to choose afinal design after weighing these factors.

The central biasing members of the H-type fasteners of the presentinvention can have various cross sections as seen in FIGS. 13-20.Referring to FIG. 13, a cross-section of a preferred embodiment is seenwherein the cross-section 210 is a substantially circular cross-section.A substantially oval cross-section 215 is illustrated in FIG. 14.Illustrated in FIG. 15 is a substantially rectangular cross-section fora biasing member of the H-type fasteners of the present invention.Illustrated in FIG. 16 is a cross-section 220 comprising two squarecross-sections 223 and 222 having diagonals 227 and 228 which areconnected along the diagonals 227 and 228 at the corners 224 and 225.Illustrated in FIG. 17 is a cross-section consisting of two circles 232and 233 attached tangentially along their circumferences at point 234.

Illustrated in FIG. 18 is a cross-section having central rectangularsection 242 having ends 243 and 244 with circular sections 247 and 246extending from ends 244 and 243. FIG. 19 illustrates a rectangularcross-section while FIG. 20 illustrates a cross-type or X-typecross-section having intersecting legs 265. It will be appreciated bythose skilled in the art that equivalent cross-sections for the biasingmember may be chosen. The central connecting members on the anchors ofthe present invention having biasing anchors such as seen in FIG. 12 mayhave similar cross-sections if desired.

The tissue anchor members useful on the H-type fasteners of the presentinvention can have various configurations including rods, disks, cones,spheres, and the like and equivalents thereof. The tissue anchor membersmay also be configured like structural members having openings thereinsuch as an X-shaped member or a ring member having spokes, or an I-beam,T-beam, etc., and the like and equivalents thereof. In addition,although it is preferred that the anchor members are fixedly mounted tothe biasing member or connecting member, the anchors may be rotatablymounted using conventional mounting configurations such as ball andsocket joints, rivets, pins, snap rings, shafts, bushings, and the likeand equivalents thereof.

The H-type fasteners of the present invention can be utilized in manytypes of surgical procedures to approximate various types of mammaliantissue. The types of tissues which can be approximated include, but arenot limited to, ligaments, cartilage, stomach tissue, intestinal tissue,muscle including skeletal muscle, cardiac muscle and involuntary muscle,bone, skin, nervous tissue, blood vessels and connective tissues. It isparticularly preferred to use the H-type devices of the presentinvention to approximate cartilage. In particular, tears in cartilagesuch as that contained in the meniscus of the knee. The H-type fastenersof the present invention are typically utilized in the following manner.Referring to FIGS. 21-29, a meniscus 300 is seen to have a tear 310. Thetear 31 is seen to extend from the top 302 of meniscus 300 to the bottom303 as seen in FIG. 22. The size of the meniscus 300 may be measuredusing a conventional arthroscopic meniscal measuring device 320 withgradations 322 as seen in FIG. 23. Once the surgeon has measured thesize of the meniscus 300, he is able to select an H-type fastener of thepresent invention which will properly approximate the tear 310 byexerting a biasing force on the tissue on either side of the tear 310.For example, fastener 90 of the present invention as illustrated inFIGS. 6 and 6A is loaded into a conventional H-type fastener insertionneedle delivery device 400 as illustrated in FIGS. 30 and 31. The device400 is seen to have distal needle cannula 410 having passageway 415,slot 417 in communication with passageway 415 and distal piercing point412. Mounted to the proximal end 419 of cannula 410 is optional retainercollar 420. Collar 420 is seen to have slot 422 and hook member 425.Proximal leg locking members 440 are seen extend proximally from distalend 419 and are separated by space 441. Each leg has distal base section445 forming a living hinge and proximal tab members 446. Device 400 ismounted to insertion cannula 500 by depressing the members 440 inwardlyand inserting the proximal tab members into passage 510 and locking thetab members 446 in slots 520 contained in cannula 500. Device maysimilarly be removed form cannula 500 by depressing locking leg members440 inwardly and thereby causing tab members 446 to dislodge form slots520. Push rod 530 is seen to be slidably mounted in the passage 510 ofcannula 500. H-type fastener 90 is loaded into device 400 by loading onetissue anchor 100 into cannula passageway 415 and the opposed anchor 100into hook member 425, with biasing section 92 protruding through slots417 and 422. Once the device 90 is loaded into the distal cannula 410 ofdelivery device 400, the surgeon then inserts the piercing point 412through the meniscus 300 such that the needle cannula 410 travelsthrough the meniscus and through tear 310. The surgeon then actuates thepush rod 530 to push the tissue anchor member 100 through cannula 410such that it is positioned adjacent to the surface 305 of meniscus 300.The surgeon then withdraws the needle cannula 410 thereby causing theother anchor 100 to be stripped from the anchor collar hook 425 andfurther causing biasing member 92 to be displaced from cannula 410 andcausing the other anchor 100 to be positioned about the surface 307 ofmeniscus 300. The extended biasing member 92 exerts a biasing force uponanchors 100 thereby causing the anchors 100 to move inwardly withrespect to each other thereby approximating the issue about tear 310.The procedure is repeated to insert additional H-members 90 until theentire tear 310 is approximated as seen in FIGS. 27-29. A similarsurgical procedure can be performed in a similar manner utilizing H-typefasteners of the present invention having biasing tissue anchors such asthe fastener illustrated in FIGS. 12 and 12A.

The following example are illustrative of the principles and practicesof the present invention.

EXAMPLE

A patient was prepared for surgery and anesthetized using conventionalprocedures. Trocar cannulas were inserted into the capsule surroundingone of the patient's knees in accordance with standard arthroscopicprocedures and a flow of saline was established to insufflate the joint.A conventional arthroscope was inserted into one cannula to visualize atear in the patient's meniscus. After measuring the meniscus with aconventional meniscal measuring device, an appropriately sized H-typefastener of the present invention was mounted in a cannulated needle andinserted into a trocar cannula. The point of the needle was insertedthrough the meniscus and the needle was withdrawn, thereby placing thefastener in the meniscal tissue surrounding the tear and approximating asection of the tear. Two more fasteners were placed in the meniscus inthe same manner thereby repairing the meniscal tear. The cannulas werethen removed from the patient's knee and the trocar puncture wounds wereapproximated in a conventional manner.

The H-type fasteners of the present invention have many advantages. Thefasteners facilitate tissue approximation in minimally invasive surgicalprocedures such as arthroscopic, endoscopic and laparoscopic procedures.The fasteners of the present invention apply a biasing force upon tissuewhich may facilitate healing. The fasteners are particularly useful inapproximating tissue, especially tissue such as meniscal cartilage.

Although is invention has been shown and described with respect todetailed embodiments thereof, it will be understood by those skilled inthe art that various changes in form and detail thereof may be madewithout departing from the spirit and scope of the claimed invention.

We claim:
 1. An H-type fastener for tissue, comprisinga central biasingmember, said central biasing member having a first end, a second end,and a cross-section, said central biasing member capable of beingelastically deformed from a first relaxed resting position to a secondextended position; a first anchoring member mounted to the first end ofthe biasing member; and, a second anchoring member mounted to the secondend of the biasing member, wherein the cross-section comprises a pair ofsquares, each square having corners and a diagonal, the squaresconnected to each other at one of said corners along the diagonal.
 2. AnH-type fastener for tissue, comprisinga central biasing member, saidcentral biasing member having a first end, a second end, and across-section, said central biasing member capable of being elasticallydeformed from a first relaxed resting position to a second extendedposition; a first anchoring member mounted to the first end of thebiasing member; and, a second member mounted to the second end of thebiasing member, wherein the cross-section comprises a pair of circleshaving circumferences connected at one point about their circumferences.3. An H-type fastener for tissue, comprisingan elongated centralconnecting member, said elongated central connecting member having afirst end, a second end, and a cross-section; a first anchoring membermounted to the first end of the connecting member, said first anchoringmember capable of being elastically deformed from a first relaxedresting position to a second extended position; and, a second anchoringmember mounted to the second end of the connecting member, said secondanchoring member capable of being elastically deformed from a firstrelaxed resting position to a second extended position, wherein theanchoring members have a V-shaped configuration comprising two angulatedlegs connected at an apex and wherein the apex of each anchoring memberis mounted to an end of the elongated central connecting member.